Chamber and committees

People are always wary of change, and sometimes we tend to look at the possible negatives and challenges rather than the opportunities. There are a huge amount of opportunities here. As I said, I am happy to continue to engage with, and listen to, the housing and homelessness sector and other sectors. I want them to be involved in the co-design process so that we get the service absolutely right. Homelessness services may not be in the NCS, but we very much need those voices in order to get the connections right.

As I have already made clear, for many issues, we cannot wait for the national care service. That is why the Government has invested in the sector. There have been two pay rises in a year. As I highlighted earlier, we recognise that there is much that we could and should do now, and we are doing that. Joint work with COSLA to advance the fair work agenda is happening now. We recognise the pressures that are out there. That is why we have invested money to combat what we will face over the course of this winter.

Some folk have accused us of concentrating our efforts on the national care service. This is the third committee that I have been at in a fortnight, so it may seem that way to folk from outside. However, the cabinet secretary Humza Yousaf and I are dealing daily with what is happening here and now. You heard from Rachel Cackett earlier. She has been involved in a number of meetings in the past couple of weeks with folks from across the sector to ensure that we are making advances in reducing delayed discharges, for example, to stand us in the best possible stead as we move into winter. It will be a tough winter for social care and for the NHS, but we must do all that we can to make as many mitigations as possible, in order to do the best that we can in that period of time.

We have said that we will form local care boards, and people have been trying to get me to say who should be on those boards. There are some folks who obviously should be, but that is really a matter for the co-design process. What I will say—I am adamant about this—is that the voices of lived experience should be on care boards and should have voting rights, which in many settings they have not previously had. Obviously, there are people who will definitely, or are likely to, be there, such as elected members of local authorities, trade unions and employees—the list goes on. However, it is not for me to dictate who should be on those boards; that has to be part of the co-design process.

The key element is getting the national high-quality standards right in order to end the postcode lotteries. In relation to the other side of my portfolio, which is mental wellbeing, I am doing something similar by introducing standards for various treatments. We now have new child and adolescent mental health services standards and specifications, which should allow change across Scotland in how services are delivered, with services improving.

You have heard me and others say that, because of the way in which delivery was changed to be much more community focused, CAHMS in Grampian got through the pandemic period in fairly good shape. The health board still delivers for people, has much lower waiting times and, in the main, meets its targets. We need those same standards everywhere. That is what we have done on CAHMS, and we are about to do the same in relation to psychological therapies. I intend to do that across the board. Those quality standards and specifications are important for ending the postcode lotteries.

Beyond that, and because all of that will be at the forefront of our minds, we also need to change the cultures that have built up in certain places that impede good service delivery and good care and support for folk. I come back to my point about not only having high-quality standards but making sure that good practice is exported across the board, because it often is not. The flexibility in the system at a local level will still lead to different ways of working, and we should learn from those and make sure that the best ways become the norm.

That follows on almost perfectly from the convener’s question.

Feedback from stakeholders has made a number of things clear. They have said that they want ministers to be accountable for the delivery of social care and they want the voices of lived experience to be central to the shaping of a national care service. Having a framework bill allows us to achieve those things.

The bill sets out the framework for the changes that we want to make, and the principles that will be absolutely central to the national care service. It allows the Parliament an important opportunity to scrutinise and influence that framework. That is immensely important, given the scale of what is involved.

It also gives us the ability to gradually build what is required, through consulting and listening to people, so that we have the right secondary legislation, which is adaptable and flexible as we move forward. All the way through the process, we have to ensure that we have people at the very heart of the co-design and building of the service.

I have spoken about the incremental change that has happened over the past two decades or so. Despite the fact that that was done with the best of intentions, there are definitely gaps in implementation—we have made moves, but we still have gaps in service. We need to plug those gaps. Some folk out there would argue that some of those are not gaps but gaping chasms. The best way of plugging those gaps is to listen to people, all the way through the journey, in order to get it absolutely right.

We will make it as easy as possible for folk to engage, and we will continue to listen to what people say about the barriers to engagement that may exist. I canna stress this enough, however: many individuals with lived experience and many organisations, particularly some disabled people’s organisations, want the change to happen yesterday, in effect. That is the reality.

Covid shone a light on some areas where we do not do well for people, and people want to see change now. Many activists with lived experience have been seeking change for 20 or 30 years—even 40 years, in some cases. I had better not name any individuals, as I might get into trouble for being ageist, but a lot of folk have been at this for a long time, and they have put a lot of work and graft into trying to get the change that they think is necessary. Those folks really want things to be done now; they do not want any more delay. I say again: they want movement now. We are doing some things in the here and now to improve things, but folks want to see that change.

We are not seeing many folk shying away from engagement—and that engagement does not have to be through the lived experience experts panel. My officials and I have gone out and engaged with people right across the country, and we will continue to do so. We will take the snippets and the suggestions from everything that we pick up on a daily basis, as well as looking to the suggestions and comments from the panels, stakeholder groups and so on.

Again, at this moment I am not going to commit either way on whether drafts will be issued. However, I will say that, as always, I want to be as co-operative and collaborative in all this work as I possibly can be, not only with the voices of lived experience, stakeholders, local government and the third sector but with the Parliament.

The framework bill is similar to the one that was used to create the national health service. As I have said, it is a big piece of work and it involves probably the biggest reform in this area. I want there to be co-operation and collaboration right across the board. I know that there will be areas where we will agree and others where we will disagree—sometimes greatly. However, as always, I will have my door open and will do whatever is required to achieve the ultimate level of co-operation. Committee members who have worked with me previously will know that that is the case.

It could have huge impacts on the way that people think about care.

We have the ability to create a profession that can attract people. I should expand on the career progression aspect. Sometimes, we do not make it easy for people to change, swap and be flexible in their careers. Sometimes, it is not easy to move from care to social work or the health service. From talking to young folk who are working in care, I am aware that that is a frustration for them especially. Getting that right, building opportunities and attracting younger folk to the care profession could bring about a real change in the thinking about care and in its culture. That is one impact.

There is a great opportunity to change the way of thinking about care beyond that, which we are trying to do. Many people feel that they are seen as a burden because they require care. That should not be the case. The investment that we are making in care is for the greater good of our society as a whole.

I will give you a language example. I do not like the term “respite” much. That is why we are talking about short-term breaks, and it is one of the reasons why the right to short-term breaks is part of the bill.

There are many changes that can take place with the bill, as is always the case with such bills. Discussions about big pieces of work such as the bill often get folks thinking differently.

It would be daft of me to commit to a timeline on any aspect of the bill for the simple reason, which I have highlighted, that we want to have the voices of people with lived experience and stakeholders at the very heart of all this. Co-design work canna go on forever but, at the same time, we have to enable people to feel that the time that they are taking is right.

It would also be wrong of me to give any indication of timelines for secondary legislation, because those are a matter for Parliament rather than for me. However, I will say that I want to give folks, including those in the Parliament, the ultimate opportunity to scrutinise what we are doing in order to get the secondary legislation right. I know that parliamentary processes can sometimes be onerous, but it is not up to me to decide those timelines.

If the committee wants to discuss some more technical aspects of the process, I will be happy for Ms Kynaston to come in. However, it would be daft of me to commit to timelines, many of which I would have no say over anyway.

Self-directed support is a big bugbear for me, I have to say. It is probably also a bugbear for many of the folk around the table. The legislation on that had cross-party support. It was all done for the best of intentions and all in primary legislation. Unfortunately, folk out there have not stuck with the spirit of the legislation but have tried to find flaws and loopholes in it to deny people their right to self-directed support. Again, there is a postcode lottery across the country in folks’ ability to access self-directed support. That is not good enough.

I have had folk working for a lengthy period on changing the guidance on self-directed support. I think that we will publish the new guidance in the next couple of weeks. That will be helpful in teasing out some of the difficulties that exist, but it will not do everything.

That is one of the reasons why a lot of what we are doing with secondary legislation is important. It means that we can be flexible and adaptable if we do not get the legislation quite right, whereas the legislative vehicle to change a piece of primary legislation is often lacking and it takes a long time. Flexibility and adaptability are the key points on that.

I am not—at all—ruling out putting the right to independent living in the bill, but I want to listen to the Jim Elder-Woodwards of this world about what is required and what we actually need to achieve. Is that best done through primary legislation or through secondary legislation, which has more flexibility and adaptability? I assured Ms Duncan-Glancy that we will look at and listen to what we get from lots of folks like Jim and we will move accordingly.